Liver Transplantation for Non-hepatocellular Carcinoma Malignancy: A Single-Center Experience.

BACKGROUND: Liver transplantation has become an effective treatment for selected patients with hepatocellular carcinoma with excellent outcomes. More recent reports have described improved outcomes in liver transplantation in a subset of patients with other malignancies like hilar cholangiocarcinoma, unresectable hepatic epithelioid hemangioendothelioma and hepatic metastasis from neuroendocrine tumors. However, hepatic angiosarcoma remains an absolute contraindication to liver transplantation because of the poor outcome. OBJECTIVES: The present study aims to describe liver transplantation for non-hepatocellular carcinoma malignancy. METHODS: A retrospective analysis of patients and review of the literature was performed. RESULTS: A total of 5 patients with non-hepatocellular carcinoma malignancy on explants histopathologic findings were identified. They presented hepatic epithelioid hemangioendothelioma (1), neuroendocrine tumor (1), angiosarcoma (1) and cholangiocarcinoma (2). The mean length of follow-up was 22.8 ± 37.67 (range, 2-90 months). Of 5 patients evaluated, 3 patients remain with stable graft function. CONCLUSION: Future investigations are necessary to redefine the indications of liver transplantations to treat non-hepatocellular carcinoma malignancy and its limitation.

Angiopoietin-2: A Potential Mediator of the Glycocalyx Injury in Adult Nephrotic Patients.

INTRODUCTION: Glomerulopathy is a group of diseases that affect mainly young adults between the ages of 20 and 40 years. Recently, it has been demonstrated that syndecan-1, a biomarker of endothelial glycocalyx damage, is increased in nephrotic patients with near-normal renal function and it is important to endothelial dysfunction in these patients. Angiopoietin-2 (AGPT2) is an endothelial growth factor that promotes cell derangement. Here we evaluated AGPT2 levels in patients with nephrotic syndrome, near-normal renal function and the possible interaction of AGPT2 with endothelial glycocalyx derangement. METHODS: This was a cross-sectional study performed from January through November 2017. Adult patients (age > 18 years) with nephrotic syndrome and without immunosuppression were included. Blood samples were drawn after a 12 h fast for later measurement of syndecan-1 and AGPT2. Mediation analyses were performed to assess the hypothesized associations of nephrotic syndrome features and AGPT2 with syndecan-1. RESULTS: We included 65 patients, 37 (56.9%) of them female, with primary glomerular disease. Syndecan-1 in nephrotic patients was higher than in control individuals (102.8 ± 36.2 vs. 28.2 ± 9.8 ng/mL, p < 0.001). Correlation of syndecan-1 with the main features of nephrotic syndrome after adjustment for age and estmmated glomerular filtration rate (eGFR) demonstrated that syndecan-1 was significantly associated with 24-h urinary protein excretion, total cholesterol, LDL (low density lipoprotein)-cholesterol, HDL (high-density lipoprotein)-cholesterol, and triglycerides. Angiopoietin-2 was independently associated with serum albumin, 24 h urinary protein excretion, total cholesterol, and LDL-cholesterol, in addition to being strongly associated with syndecan-1 (0.461, p < 0.001). The results of the mediation analyses showed that the direct association between LDL-cholesterol and syndecan-1 was no longer significant after AGPT-2 was included in the mediation analysis. AGPT2 explained 56% of the total observed association between LDL-cholesterol and syndecan-1. CONCLUSION: The association between LDL-cholesterol and glycocalyx derangement in nephrotic patients is possibly mediated by AGPT2.